Validation and characterization of transcatheter aortic valve effective orifice area measured by Doppler echocardiography

Authors: Clavel, Marie-Annick; Rodés-Cabau, Josep; Dumont, Éric; Bagur, Rodrigo Hernan; Bergeron, Sébastien; De Larochellière, Robert; Doyle, Daniel; Larose, ÉricDumesnil, Jean G.Pibarot, Philippe
Abstract: Objectives : The objectives were to compare different Doppler echocardiographic methods for the measurement of prosthetic valve effective orifice area (EOA) following transcatheter aortic valve implantation (TAVI) and to determine the factors influencing the EOA of transcatheter balloon expandable valves.
Background : Previous studies have used different methods for the measurement of the valve EOA following TAVI. Factors influencing the EOA of transcatheter valves are unknown.
Methods : A total of 122 patients underwent TAVI with the use of the Edwards-SAPIEN valve (Edwards Lifesciences, Irvine, California). The EOA was measured by transthoracic echocardiography at hospital discharge, 6 months and 1 year after TAVI with the use of 2 methods as described in previous studies. In Method #1 (EOA1), LVOT diameter (LVOTd) entered in the continuity equation was measured at the base of prosthesis cusps whereas, in Method #2 (EOA2), LVOTd was measured immediately proximal to the prosthesis stent.
Results : The average EOA2 (1.57 ± 0.41 cm2) was larger (p < 0.01) than the EOA1 (1.21 ± 0.38 cm2). Accordingly, incidence of severe PPM (indexed EOA =0.65 cm2/m2) was 3-fold lower with the use of EOA2 than with EOA1 (9% vs. 33%; p < 0.001). Mean transprosthetic gradient correlated better (p = 0.03) with indexed EOA2 (r = -0.70, p < 0.0001) than with indexed EOA1 (r = -0.58, p < 0.0001). Intraobserver and interobserver variability were lower for EOA2 compared to EOA1 (intra: 5% vs. 7%, p = 0.06; inter: 6% vs. 14%; p < 0.001). Aortic annulus size was the sole independent determinant (p = 0.01) of prosthetic valve EOA2. The average EOA varied from 1.37 ± 0.23 cm2 for aortic annulus size <19 mm up to 1.90 ± 0.17 cm2 for size >23 mm.
Conclusions : When estimating the EOA of Edwards-SAPIEN valves by Doppler-echocardiography, it is recommended to use the LVOT diameter and velocity measured immediately proximal to the stent. The main determinant of the EOA of transcatheter valves is the patient's annulus size and these valves provide excellent hemodynamics even in patients with a small aortic annulus.
Document Type: Article de recherche
Issue Date: 4 October 2011
Open Access Date: Restricted access
Document version: VoR
Permalink: http://hdl.handle.net/20.500.11794/2309
This document was published in: JACC : Cardiovascular Imaging, Vol. 4 (10), 1053–1062 (2011)
http://dx.doi.org/10.1016/j.jcmg.2011.06.021
American College of Cardiology
Alternative version: 10.1016/j.jcmg.2011.06.021
http://www.ncbi.nlm.nih.gov/pubmed/21999863
Collection:Articles publiés dans des revues avec comité de lecture

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